POS0387 IMPACT OF RHEUMATIC DISEASE SUB-TYPES ON MATERNAL AND NEONATAL OUTCOMES: A POPULATION LEVEL ANALYSIS
Authors: S. Keeling, A. Savu, P. Kaul
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> There are limited data on the differing effect of rheumatic diseases (RD), including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA) and systemic lupus erythematosus (SLE), on maternal and neonatal outcomes. <h3>Objectives</h3> We evaluated the impact of four rheumatic diseases (RA, SpA, PsA and SLE) on maternal and neonatal outcomes at a population level. We also examined medication use during pregnancy across these four groups. <h3>Methods</h3> A contemporary pregnancy cohort of 452,273 singleton live birth events of 307,590 women was assembled for the province of Alberta, Canada. We identified 5 groups: (1) no rheumatic disease (no RD, n=449,933 pregnancies), (2) RA (n=1214), (3) PsA (n=177), (4) SpA (n=445) and SLE (n=504). We compared maternal and neonatal outcomes, comorbidity burden, and medication use among the 5 groups. <h3>Results</h3> Across all groups, mothers were predominantly ethnically Caucasian (&gt;90%), residing in urban residences (&gt;75%), and multiparous (&gt; 58%). Maternal comorbidities including renal, vascular diseases and hypertension were most prevalent in SLE mothers. Rates of preclampsia, caesarean section and induction were highest in mothers with SLE. Pregnant women with SLE were the most likely to have preterm delivery (18.3%) and NICU admission at birth (21.8%) followed by RA (preterm delivery 11.3%, NICU admission at birth 12.8%) compared to those with PsA, SpA or no RD (Figure 1). Prednisone use for at least 28 days or any duration during pregnancy was highest amongst mothers with SLE (8.9%) followed by RA (7%) (Table 1). Antimalarial use for at least 28 days or any duration during pregnancy was highest in SLE mothers (32.7%) followed by RA mothers (18.5%) while biologic medications were used mostly in mothers with RA (10.5%). <h3>Conclusion</h3> Women with SLE had the worst maternal and neonatal outcomes and highest medication use followed by RA, with varying degrees for those with PsA and SpA compared to controls. The extent to which these outcomes are related to differing medication use, such as higher rates of prednisone and lower rates of antimalarials in mothers with SLE, and lower use of biologics in RA mothers, requires further exploration. <h3>References</h3> [1]Keeling SO, Bowker SL, Savu A, Kaul P. A population-level analysis of the different effects of rheumatoid arthritis and spondyloarthriits on peripartum outcomes. <i>J Rheumatol</i> 2020;47(2):197-203. [2]Andreoli L, Chighizola CB, Iaccarino L, Botta A. et al. Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11<sup>th</sup> International Conference on Reproduction, Pregnancy and Rheumatic Diseases. <i>Autoimmunity Reviews</i> 2023;22(3): 103259. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests:</h3> Stephanie Keeling Speakers bureau: Abbvie, GSK, Janssen, UCB, Consultant of: Abbvie, Amgen, GSK, AstraZeneca, Janssen, Sandoz, UCB, Ana Savu: None declared, Padma Kaul: None declared.